by AB Morgan
Mark took the time to make a rapid first impression assessment of Richard. He was smartly dressed as expected, appeared efficient, and had been careful to ensure that he had the notes he needed before he formally introduced himself to Mark, and added, ‘I’ve brought a pen and paper with me as I understand you prefer not to speak at the moment.’
Mark was struck by the firm authoritative manner of Richard’s opening statement. ‘That is not strictly true,’ responded Mark. Richard smiled knowingly, and sat back in the well-worn office chair. The office door had a window in the top half, and across this was a curtain, partially pulled back. From the outside, it revealed Richard sitting at the desk, however, Mark, sitting opposite, was obscured from the view of any passer-by. No one would see him speaking.
To Mark’s surprise, Richard’s first question was, ‘Is your name Mark El Amin by any chance?’
It was Mark’s turn to smile and give a short snort of a laugh through his nostrils. He realised that Lewis James had been in touch with Huntley and Greaves, and helpfully he was now fully aware that he needed to stick firmly to his false identity and cover story. ‘How did you find that out?’
Richard explained, in brief, that Mark’s parents had been searching for him, and the family solicitor, a Mr James Lewis, had contacted Richard’s office. Richard said he had wanted to check the validity of this story with Mark before responding to the call from Mr Lewis in London. ‘You should perhaps call him yourself to put your parents’ minds at rest, especially living so far away.’
Mark paused, nodded, and ‘ummed’, playing for time before replying. He was surprised that his cover story included parents, and where did they live, Scotland? How far away is far away?
Richard unknowingly came to his rescue. ‘I don’t suppose you have enough money on you to call Australia, and I’m almost sure the ward can’t run to permission for a call. It would be cheaper and more sensible to ask your family solicitor to update them with the news that you have been found alive and well. Are you well?’
‘Yes, apart from being stuck in here, I’m fine, thanks. I shouldn’t be in here.’
When Richard smirked at this turn of phrase, Mark realised that he must have heard that comment many times. Mark wagered that most of Richard’s clients would try to convince him that they shouldn’t be in Pargiter Ward.
‘Tell me if you would, how you ended up here,’ invited Richard, ‘and please excuse me if I write down the specifics – they can be more important sometimes. I need a chronology of events, if you can run to that.’
Mark could, and did. He had his cover story at the ready and Richard nodded sagely as he wrote down the details. A couple of times he asked for clarification, but on the whole he allowed Mark to talk through the chronology of events unhindered by interruptions. Mark reassured himself that he had done an excellent job of passing himself off as an eternal student.
Once finished, Richard looked at Mark intently and asked, ‘Why haven’t you told the staff or the consultant what you have just told me?’
‘It’s like a bad dream,’ Mark said. ‘I feel alright now, but I didn’t know what to do for the best, so I waited until I had the opportunity to speak to you, someone independent.’
He tried to hold Richard’s gaze, conscious that Richard was sceptical about his version of events. Mark knew that as a solicitor, Richard was used to not being told the truth, and Mark had noticed him cross-checking a couple of facts before deciding to scan through the formal hospital admission paperwork. There were a lot of papers in front of Richard, requiring careful consideration. On the desk was a Section 3 recommendation form and Mark spied the name Dr Giles Sharman next to a swirl of a signature. Richard picked up the form and scrutinised it for several seconds.
Mark remained positive that Richard would prove to be as thorough as Monica had led him to believe, but despite this optimistic view, he shifted in his seat uncomfortably. This man knows his stuff, Mark realised as he watched Richard taking in the facts.
Richard read through the words written on the Section paper by Dr Sharman, and as he did so Mark noticed a couple of significant changes in Richard’s facial expression. As Richard’s eyebrows shot upwards, he said, ‘Oh, I see you already have a diagnosis of schizophrenia.’ Richard looked up expectantly at Mark from the sheet of paper he was holding.
Mark was visibly shocked by this revelation. ‘Do I? Since when?’
‘I was about to ask you the same question. According to the information in front of me, you are known to mental health services and have a diagnosis of schizophrenia, and this admission was due to a relapse. What medication were you on before?’ Richard asked. Mark knew he was hunting for the truth.
‘I wasn’t,’ replied Mark who was feeling uncomfortable. There had been a mistake made somewhere along the line. ‘I don’t have a mental illness. I don’t have a diagnosis of any mental illness, and I have never been on medication for a mental illness, until this week that is.’
‘Leave this with me,’ Richard said looking puzzled. ‘I wonder if there has been a mix-up.’
‘There must have been. I truly don’t have any diagnosis. Actually …’ Mark said, hesitating, ‘I need to know whatever you find, and I want to be able to trust you. I will talk to the nurse and tell her what I’ve told you. If I have to, I’ll even speak in ward round to Dr Sharman, but I have to say that when I saw him, in fact the only time I have seen him so far, that man was convinced that I have psychosis. I hadn’t even spoken and he accused me of being paranoid. Perhaps, when he hears what I have to say, he will remove this bloody Section. Then, hopefully, I can be discharged.’ Mark realised that in part he was fooling himself with his own optimism.
Richard agreed that it would be more sensible for Mark to communicate openly, and in the meantime he would continue with preparation of reports, ‘I’ll carry on, in case it goes ahead,’ he confirmed with a conciliatory grin.
Mark liked Richard from the word go. He approved of his directness and sharp intellect. Richard didn’t patronise him, and Mark felt guilty for having to deceive him. Following his first meeting with Richard, he was of the opinion that progress had definitely been made.
He had a spring in his step as he left the office and experienced overwhelming relief at being able to speak at last. Mark was looking forward to asking questions, and to be able to interrogate and research!
Most of all, Mark could look forward to the next ward round with Dr Sharman. He would make everyone realise what a pompous self-serving arse the man was, by making the dear doctor retract his diagnosis, and stop prescribing medication that wasn’t needed. Then Mark could go home, and once he had done the background checks about this Dr Sharman scandal rumour, he could write the story.
I need to call Lewis, and perhaps he can ask my pretend parents to organise sending me some decent clothes, I can’t go home looking like this, he said to himself.
He bumped straight into Monica as he turned the corner on his way back to the dormitory to update his shorthand notes.
21
He Speaks!
‘Oh crikey! I’m sorry,’ I exclaimed, patting Mark on the shoulder by way of apology for bumping into him as I rounded the corner. ‘Hope you got on okay with Mr Huntley.’ I carried on down the corridor, not expecting a reply.
‘Yes. Thank you,’ Mark answered. I nearly toppled over in surprise. I turned and gave the biggest most genuine of smiles. ‘That’s great to hear, Mark,’ was the best I could manage in reply.
He nodded and went on his way, grinning. He had a lovely soft voice, Mr Mark Jesus Trainman. This was turning out to be a good day.
I had been marching down the corridor to deal with Dan, who had begun to cause another problem with Welsh Phil and his stash of chocolate. I needed to get to the bottom of this before another skirmish became a full-scale battle. I was so taken aback by Mark speaking, that I nearly forgot why I was dashing around the corner.
However I arrived at the scene in good time to hear Dan pl
eading with Phil not to eat any more chocolate because it would kill him.
‘No Dan, it won’t kill me. It is not poisoned, I promise,’ said Phil, trying to allay Dan’s fears. Dan was telling him that he had been reliably informed ‘by them’ that cyanide had been put in one of the bars of chocolate, and it was like Russian Roulette as to when Phil would die. Dan was adamant. He was crying, genuinely in fear for Phil’s life.
I felt like a bit of a fool. All this time I had assumed Dan was trying to steal Phil’s chocolate, because he wanted chocolate, and for no other reason. I should have known better than that, especially after working on an acute ward for so long.
If I had more time to spend with the patients and less sorting out paperwork or finding staff to cover shifts, I would have been on top of this situation long ago, I told myself. How could I have been so half-hearted in carrying out my duties? Poor Dan had been distressed and upset for days. I hated to admit it, but I had let the mystery of the lovely-looking Jesus distract me from the needs of the other patients on the ward and I was extremely disappointed with myself.
Once the immediate situation with Phil and Dan was resolved, I spent a fair bit of time with Dan. Only then did it become obvious that his delusional belief about Phil’s chocolate being poisoned was firmly fixed. There may have been a benefit in moving Dan or Phil into a side room, I thought, but I also suspected that the respite would be short lived. Still, at least Phil could have a rest at night, I concluded. So I arranged this with one of the healthcare assistants to sort out.
In the goldfish bowl office, I quickly perused Dan’s drug chart. The other patients called him ‘Dopey Dan’ in reference to the amount of cannabis he had been using leading up to his admission, which undoubtedly had contributed to his paranoia, and his eventual departure from reality. According to his drug chart, he was not on any antipsychotic medication. I searched in vain for a second chart in case one had been recently written. It made no sense to me that a man with distressing delusional beliefs was not on any medication, and so I referred to the case notes. Records from Dan’s first ward round, following his admission about four weeks previously, stated that it had been Dr Sharman’s view that, ‘This patient presents with an entirely drug-induced state. Spontaneous resolution likely within four to five days.’
I found the next ward review entry, which said the same thing in not so many words, and so it continued for each Monday ward round up to the most recent review. That one inferred that Dan was making a steady recovery, and would be ready for discharge the following week, once he had been on trial home leave. I found no record of home leave being agreed or arranged. As I usually covered Tuesday ward rounds, I must have missed the significance of the pattern. Was I not listening properly in handover meetings? This was another blow to my usual high standards. I was slipping dangerously close to incompetency.
In an attempt to redeem myself, and out of frustration, I examined the nursing reports, which to be frank, could have been describing a different person from the one seen by the psychiatrists. Every one of the nursing entries in the notes, without fail, identified on-going distress, delusional beliefs, made specific reference to paranoia, and to fears about others being poisoned. Dan had received no treatment for acute psychotic symptoms. Disgraceful.
I was not Dan’s named nurse on the ward. It was one of the night staff who had taken that role, which always made nursing representation less effective in ward rounds. Knowing this, I went on a personal mission, to look up the care plan review details and discover the truth behind Dan’s lack of progress. Sadly the reviews did not reveal much of use, as the records were sketchy at best. Going through the main notes, however, I picked out at least one phone call a week from the named nurse to one of the doctors requesting a review of the treatment plan, which only consisted of a dose of night sedation and Lactulose for constipation.
‘What good is that for delusions?’ I asked myself out loud. ‘What’s the matter with Dr Sharman? He seems to be making it up as he goes along! In fact he’s so full of shit, that maybe he should take a laxative. It might cure his delusion that he’s a psychiatrist.’
Maybe he is making it up, I convinced myself as I reached for the phone to contact the on-call doctor and make my request, politely but firmly, for active treatment of Dan’s psychosis.
Dr Siddiqui was on-call again. He was always on call it seemed. I explained the situation, and made my request for commencement of antipsychotic medication. ‘Perhaps one of the newer medications and a small dose to start with. It may help him sleep as well,’ I ventured.
‘No, I don’t think so,’ he replied. ‘Dr Sharman is clear that symptoms will remit now that the gentleman concerned is no longer under the influence of the cannabis.’
‘They haven’t remitted, Doctor, and they have become decidedly worse recently. In fact, we have had a number of incidents recorded that have been as a direct result of his delusions. Of course it may be the case that Dan has been self-medicating with cannabis, to manage underlying mental health problems.’ I said, dragging up the best argument I could muster at short notice.
‘Hmm … Dr Sharman will see him in ward round next Monday or Tuesday and he can review the situation then, I think,’ came the vague reply down the telephone line. I would have happily strangled the man with the flex if he had been in the vicinity, and I was astounded at his lack of compassion. Was he actually suggesting that the whole situation was not even discussed until the following week? It was Friday, and there was a whole weekend to get through when the Chocolate War could easily escalate to include other foodstuffs, and other people.
‘Dr Siddiqui, I can’t write that in the case notes, can I? After all, it would look as if you were refusing to assess or treat a patient in distress, wouldn’t it? I’m sure you don’t mean that to happen.’ Argue that point, I thought.
‘Oh, no, of course not,’ he inevitably responded. ‘I’ll come up in a couple of minutes when I have spoken to Dr Sharman about what to do in this man’s case.’
‘Why do you need to ask him first?’ I challenged, careful not to sound too forceful. ‘He may give you a hard time if you haven’t at least spoken to the patient and reviewed the notes before you ask his opinion. He can be touchy about that sort of thing can’t he?’ I played yet another fine card with that suggestion.
‘Okay, I’ll come there first.’
I put the phone down, and ran my fingers through my scalp. As I lifted two clumps of hair towards the ceiling, shouting ‘aaaargh’ to no one in particular, Richard Huntley came to the ward office door, and laughed at my obvious despair.
‘Sorry,’ I muttered. ‘And there was I, thinking that the day was getting better. How can I help, assuming you need help with something?’
‘You’re always helpful, Monica. Our mystery man decided to speak to me …’
‘Yes, I bumped into him a moment ago. It was a bit of a shock.’
‘And,’ continued Richard, ‘I’m sure you can straighten out the queries I have in the case of Mr Trainman as was. Mark. He is, by the way, called Mark El Amin; you may want to make a note. Firstly, I need to know if has he been told of his diagnosis, either verbally or in writing or both?’
I slumped in my chair in a rather exaggerated fashion as I motioned for Richard to take a seat. ‘I don’t think either apply. There’s nothing in his ward notes to confirm a diagnosis given by Dr Sharman, but when he was admitted, Mark had a working diagnosis or query around a drug induced episode, made by Dr Siddiqui.’
That was the truth as far as I knew. ‘However,’ I said, ‘I couldn’t help noticing that the Section 3 recommendation outlined that he was a known patient and had a diagnosis of schizophrenia, which didn’t make any sense …’
I then went on to explain to Richard, in confidence, that I had followed this up with Dr Sharman, who had denied previously knowing the patient. I found myself asking Richard for help. Not for myself, but for Mark, who I was sure did not have a mental illness. ‘He might hav
e had a bit of a weird moment, and it could have been drugs, who knows, but he’s not displaying anything indicating psychosis. Nothing. His sleep is terrible, mind you, and he gets night terrors, but that’s pretty much it.’
I shared my fears with Richard that Mark might be using the ward as a place to hide, and that I wasn’t sure why he was here. ‘Some of the patients are questioning this too,’ I added. ‘Still, we shall soon know more, now that he’s speaking.’
Richard was pragmatic about the whole thing. He planned to do what he usually did, and that was to scrutinise the records, cross reference the facts, prepare himself, and give the ward team and Doctor Sharman a hard time at the appeal hearing.
As a result of my wobbly emotional state, I then let slip an awful comment, ‘Perhaps you could check to see if he is a real doctor while you’re at it …’
When Richard looked at me expecting me to be smiling as if I had made a joke, he didn’t see a smile. He saw tears in my eyes, and a slight quiver run across my lower lip. I bit my lip and turned away from him sharply, ending the conversation as I stood up. ‘Never mind. Just thinking out loud.’
As I said that, Dr Siddiqui popped his head round the door. I handed him Dan’s notes, and informed him rather abruptly that I would be with him in a minute.
‘Sorry Richard, you had other questions you wanted to ask,’ I said, trying to get a grip on my emotions, and wondering if my hormones were playing up.
‘No, don’t worry for now. I shall no doubt work them out for myself. I may be a bit longer, so is it okay with you to use that office for the next hour or so?’
‘Of course, it’s no problem.’
I left Richard to it, and after a while forgot he was there. My next task was to escort Dr Siddiqui to see Dopey Dan. Even he could not deny that the poor man needed proper medication to help him. My efforts were finally rewarded after I had almost exhausted myself persuading Dr Siddiqui to act on his own accord. When he wrote out the drug chart, I made sure it was taken immediately to the hospital pharmacy, so that we could get Dan started on treatment without further delay. I had even managed to ensure he was not prescribed Haloperidol or Droperidol for a change. Hurrah!
